Abstract
Background The purpose of this single-center, retrospective study was to review the early outcome
with defined endpoints of myocardial infarction, brain injury, and death after coronary
bypass grafting and simultaneous carotid endarterectomy with or without combined valve
replacement.
Methods During the preoperative investigation 52 (44 males, 8 females) patients were examined
by cardiac catheterization within the scope of their coronary status. In addition,
all patients underwent echocardiography, CT angiography of the supra-aortic vessels,
and full description of their neurologic status. Included were all patients with the
need of coronary revascularization, valve disease, and either symptomatic or asymptomatic
carotid artery stenosis with a maximal narrowing of >70%.
Results There was one (2%) patient with a perioperative stroke and paresis of the upper limb.
One (2%) patient experienced PRIND (2%). Eighteen (35%) patients suffered symptomatic transitory psychotic syndrome that fully recovered in all patients. One (2%) patient incurred a perioperative myocardial
infarction that could be cured by percutaneous coronary stent implantation. Overall
mortality was 4%.
Conclusion Simultaneous coronary bypass grafting as a single procedure or in combination with
valve replacement and endarterectomy of severe carotid lesions with or without patients'
history of previous stroke can be performed with a calculated low surgical risk. The
complication rate for neurologic and myocardial events is low compared with the hazard
of a single surgical repair. The in-hospital mortality is not significantly different
to isolated procedures. The concomitant appearance of coronary stenosis and carotid
artery disease is reasonable due to the nature of arteriosclerosis. In our opinion
these patients benefit from a combined surgical approach.
Keywords
carotid arteries - cardiopulmonary bypass - coronary artery bypass grafts surgery
- coronary artery bypass grafting - neurology/neurologic (deficits disease injury)
- stroke
